Paediatrics

Question 1

Define testicular torsion.

Answer 1

A urological emergency caused by the twisting of the testicle on the spermatic cord leading to constriction of the vascular supply and time-sensitive ischaemia and/or necrosis of testicular tissue.

Question 2

Explain the aetiology / risk factors of testicular torsion.

Answer 2

Risk Factors:

• Age under 25 years
• Neonate
• Bell clapper deformity
• Trauma / exercise
• Intermittent testicular pain
• Undescended testicle
• Cold weather

Question 3

Summarise the epidemiology of testicular torsion.

Answer 3

Testicular torsion is a well known emergency in urology and can occur at any age. Our study shows that the incidence was 2.9 cases per 100,000 person years of males <25 yr of age and 1.1 cases per 100,000 person years at all ages.

Most common at ages 11-30 years.

Question 4

Recognize the presenting symptoms of testicular torsion.

Answer 4

• Sudden onset of pain in one testis
• Intermittent or acute on-and-off pain
• No pain relief upon elevation of scrotum
• Walking uncomfortable
• Abdominal pain
• Nausea
• Vomiting
• Fever
• Increased urinary frequency

Question 5

Recognize the signs of testicular torsion on physical examination.

Answer 5

• Scrotal swelling or oedema
• Inflammation of one testis - very tender, hot and swollen
• Testis may lie high and tranversely

NB: With intermittent torsion, the pain may have passed on presentation, but if it was severe, and the lie is horizontal, prophylactic fixing may be wise.

Question 6

Identify appropriate investigations for testicular torsion and interpret the results.

Answer 6

• Doppler US - may demonstrate lack of blood flow to the testis
• Only perform US if diagnosis equivocal - do not delay surgical exploration
• Urinalysis, FBC, CRP - check for infection

Question 7

Generate a management plan for testicular torsion.

Answer 7

• Ask consent for possible orchidectomy + bilateral fixation (orchidopexy)
• At surgery exposure and untwist the testis
• If colour looks good, return the testis to the scrotum and fix both testes to the scrotum

Question 8

Identify the possible complications of testicular torsion and its management.

Answer 8

• Infection
• Infertility
• Gangrene
• Cosmetic deformity
• Atrophy
• Testicular death

Question 9

Summarise the prognosis for patients with testicular torsion.

Answer 9

If testicular torsion is treated right away—at best within six hours—the testicle may be saved. But if blood flow is cut off for more than six hours, the testicle may lose its ability to function